In 1998, the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Center for Substance Abuse Treatment (CSAT) published Addiction Counseling Competencies: The Knowledge, Skills, and Attitudes of Professional Practice (The Competencies) as Technical Assistance Publication (TAP) 21.
Developed by the National Curriculum Committee of the Addiction Technology Transfer Center (ATTC) Network, TAP 21 identifies 123 competencies that are essential to the effective practice of counseling for psychoactive substance use disorders. TAP 21 also presents the knowledge, skills, and attitudes (KSAs) counselors need to become fully proficient in each competency. TAP 21 has been widely distributed by SAMHSA’s National Clearinghouse for Alcohol and Drug Information (NCADI) and the ATTC Network.
It has become a benchmark by which curricula are developed and educational programs and professional standards are measured for the field of substance abuse treatment in the United States. In addition, it has been translated into several languages. Because the ATTC Network is committed to technology transfer, after the initial publication of TAP 21, the National Curriculum Committee began exploring ways to enhance the document for future printings. Successful technology transfer requires more than presenting good information.
It entails transmitting scientific knowledge in a way that makes it understandable, feasible to implement in a real-world setting, and supportable at a systematic level—in other words, getting the right information across in a way that makes it useable. The National Curriculum Committee examined how best to package and present TAP 21 to help people learn key elements and adopt new strategies. The result was a revision of TAP 21—a process that was begun in 2000, was completed in 2005, and resulted in the current publication.
HISTORY OF THE COMPETENCIES
In 1993 CSAT created a multidisciplinary network of 11 ATTC Regional Centers geographically dispersed across the United States and in Puerto Rico and the U. S. Virgin Islands. Since its inception, the ATTC Network has collaborated with diverse international, national, State, regional, and local partners from multiple disciplines to recruit qualified addiction treatment practitioners and enhance academic preparation and professional development opportunities in the substance abuse treatment field. The National Curriculum Committee, composed of ATTC Directors, was established at the Network’s inaugural meeting.
The committee’s initial charge was to collect and evaluate existing addiction educational and professional development curricula and establish future priorities for ATTC curriculum development. This effort led to researching existing practice and professional literature and defining an extensive list of addiction practice competencies determined to be essentia l to effective counseling for substance use disorders. These initial competencies would serve as benchmarks to guide future ATTC curriculum design, development, and evaluation.
In addition to its own work, the National Curriculum Committee reviewed and incorporated other publications on the work of addiction counselors. 1 In 1995 the committee’s work resulted in the ATTC publication Addiction Counselor Competencies. Subsequent to this publication, the ATTCs conducted a national survey to validate the competencies (see appendix C). Results supported virtually all of the competencies as being essential to the professional practice of addiction counseling.
In 1996, the International Certification and Reciprocity Consortium (ICRC) convened a national leadership group to evaluate the need for model addiction counselor training. After careful deliberation, the group concluded that much of the work to define such a curriculum standard had already been accomplished by the ATTC National Curriculum Committee and the ICRC in the National Curriculum Committee’s Addiction Counselor Competencies and the ICRC’s 1996 Role Delineation Study, respectively. Soon after, CSAT agreed to fund a collaborative effort to finalize a document that could be used as a national standard.
CSAT convened a panel—The National Steering Committee for Addiction Counseling Standards (NSC)—that comprised representatives from five national educational, certification, and professional associations. The NSC was successful in achieving unanimous endorsement of the Addiction Counselor Competencies—a milestone in the addiction counseling field. Based on this foundation, the National Curriculum Committee began to delineate the KSAs that undergird each competency statement. Input was solicited from a number of key national organizations and selected field reviewers.
In 1998 CSAT published the results of this groundbreaking work as TAP 21 (The Competencies). After TAP 21 was published, the National Curriculum Committee systematically conducted focus groups and a national survey to elicit feedback from the field about the impact of TAP 21. Although feedback was uniformly positive and thousands of copies of TAP 21 were disseminated through SAMHSA’s NCADI and the ATTC Network, refinements were needed to improve the utility of the publication and enhance its effect in both the addiction practice and educational systems.
Feedback obtained from the survey and the focus groups indicated a need for additional information to help the field incorporate the competencies into daily practice. Feedback also suggested that there was no need to change the competencies. The most common suggestions were to refine the 1998 publication by presenting the content in a more user-friendly fashion and linking it to professional literature and specific applications. The National Curriculum Committee revised TAP 21 in 2000 based on the feedback of dedicated addiction practice and education professionals; however, this revision was never published.
A new Update Committee was convened in 2005 to update the revised 2000 edition with literature published between 2000 and 2005. The Update Committee consisted of some of the original members from the National Curriculum Committee; representatives from NAADAC—The Association for Addiction Professionals, CSAT, the Center for Mental Health Services, the Center for Substance Abuse Prevention, the National Association for Children of Alcoholics, and the Annapolis Coalition; treatment providers; and experts in ddiction research.
The current updated edition retains all of the feedback-based improvements of the 2000 revised version and adds relevant 1 Birch and Davis Corporation (1986). Development of Model Professional Standards for Counselor Credentialing. Dubuque, IA: Kendall/Hunt Publishing. International Certification and Reciprocity Consortium (ICRC)/Alcohol and Other Drug Abuse (1991). Role Delineation Study for Alcohol and Other Drug Abuse Counselors.
Raleigh, NC: ICRC. 2 Introduction literature published after 2000. In addition, the competencies and KSAs of several practice dimensions, in particular those that address clinical evaluation and treatment planning, were rewritten to reflect current best practices.
WHAT YOU WILL FIND INSIDE
The Model When creating The Competencies, the National Curriculum Committee recognized a need to emphasize three characteristics of competency: knowledge, skills, and attitudes.
Many hours were spent conceptualizing a differentiated model when designing TAP 21—a model that could address general KSAs necessary for all practitioners dealing with substance use disorders while explaining the more specific needs of professional substance abuse treatment counselors. The first section of the model addresses the generic KSAs. This section contains the transdisciplinary foundations, comprising four discrete building blocks: understanding addiction, treatment knowledge, application to practice, and professional readiness.
The term “transdisciplinary” was selected to describe the knowledge and skills needed by all disciplines (e. g. , medicine, social work, pastoral guidance, corrections, social welfare) that deal directly with individuals with substance use disorders. The second section of the model specifically addresses the professional practice needs, or practice dimensions, of addiction counselors. Each practice dimension includes a set of competencies, and, within each competency, the KSAs necessary for effective addiction counseling are outlined.
Many additional competencies may be desirable for counselors in specific settings. The National Curriculum Committee’s goal for the future is to help ensure that every addiction counselor possesses, to an appropriate degree, each competency listed, regardless of setting or treatment model.
The relationship of the components in the competencies model is conceptualized as a hub with eight spokes. The hub contains the four transdisciplinary foundations that are central to the work of all addiction professionals. The eight spokes are the practice dimensions, each containing the competencies the addiction counselor should attain to master each practice dimension.
Addiction Counseling Competencies Recommended Readings Journal articles, book chapters, and other critical literature for each transdisciplinary foundation and practice dimension have been reviewed and included in this document. Moreover, separate bibliographies on attitudes and recovery have been added, as have lists of Internet and cultural competency resources.
Specific proficiencies, skills, levels of involvement with clients, and scope of practice vary widely among specializations. At their base, however, all addiction-focused disciplines are built on four common foundations. This section focuses on four sets of competencies that are transdisciplinary in that they underlie the work not just of counselors but of all addiction professionals. The four areas of knowledge identified here serve as prerequisites to the development of competency in any of the addiction-focused disciplines.
THE FOUR TRANSDISCIPLINARY FOUNDATIONS
Understanding Addiction Treatment Knowledge Application to Practice Professional Readiness Regardless of professional identity or discipline, each treatment provider must have a basic understanding of addiction that includes knowledge of current models and theories, appreciation of the multiple contexts within which substance use occurs, and awareness of the effects of psychoactive drug use. Each professional must be knowledgeable about the continuum of care and the social contexts affecting the treatment and recovery process.
Each addiction specialist must be able to identify a variety of helping strategies that can be tailored to meet the needs of individual clients. Each professional must be prepared to adapt to an ever-changing set of challenges and constraints. Although specific skills and applications vary across disciplines, the attitudinal components tend to remain constant. The development of effective practice in addiction counseling depends on the presence of attitudes reflecting openness to alternative approaches, appreciation of diversity, and willingness to change.
The following knowledge and attitudes are prerequisite to the development of competency in the professional treatment of substance use disorders. Such knowledge and attitudes form the basis of understanding on which discipline-specific proficiencies are built. 5
COMPETENCY 1: KNOWLEDGE
Terms and concepts related to theory, etiology, research, and practice. Scientific and theoretical basis of model from medicine, psychology, sociology, religious studies, and other disciplines. Criteria and methods for evaluating models and theories. Appropriate applications of models. How to access addiction-related literature from multiple disciplines.
Openness to information that may differ from personally held views. Appreciation of the complexity inherent in understanding addiction. Valuing of diverse concepts, models, and theories. Willingness to form personal concepts through critical thinking. Recognize the social, political, economic, and cultural context within which addiction and substance abuse exist, including risk and resiliency factors that characterize individuals and groups and their living environments.
COMPETENCY 2: KNOWLEDGE
Basic concepts of social, political, economic, and cultural systems and their impact on drug-taking activity. The history of licit and illicit drug use. Research reports and other literature identifying risk and resiliency factors for substance use. Statistical information regarding the incidence and prevalence of substance use disorders in the general population and major demographic groups.
Recognition of the importance of contextual variables. Appreciation for differences between and within cultures. 9 Addiction Counseling Competencies Describe the behavioral, psychological, physical health, and social effects of psychoactive substances on the person using and significant others.
COMPETENCY 3: KNOWLEDGE
Fundamental concepts of pharmacological properties and effects of all psychoactive substances. The continuum of drug use, such as initiation, intoxication, harmful use, abuse, dependence, withdrawal, craving, relapse, and recovery. Behavioral, psychological, social, and health effects of psychoactive substances. The effects of chronic substance use on clients, significant others, and communities within a social, political, cultural, and economic context. The varying courses of addiction. The relationship between infectious diseases and substance use.
Sensitivity to multiple influences in the developmental course of addiction. Interest in scientific research findings. Recognize the potential for substance use disorders to mimic a variety of medical and mental health conditions and the potential for medical and mental health conditions to coexist with addiction and substance abuse.
COMPETENCY 4: KNOWLEDGE
Normal human growth and development. Symptoms of substance use disorders that are similar to those of other medical and/ or mental health conditions and how these disorders interact. The medical and mental health conditions that most commonly exist with addiction and substance use disorders. Methods for differentiating substance use disorders from other medical or mental health conditions. ATTITUDES Willingness to reserve judgment until completion of a thorough clinical evaluation. Willingness to work with people who might display and/or have mental health conditions.
Willingness to refer for treating conditions outside one’s expertise. Appreciation of the contribution of multiple disciplines to the evaluation process. 10 TF 1. Understanding Addiction Members of the National ATTC Curriculum Committee reviewed the bibliography from the first printing of The Competencies. Following previously established guidelines, the Committee reviewed and linked each reference with a specific transdisciplinary foundation. Primarily textbooks are referenced in this section; however, such texts are not mutually exclusive of the practice dimensions.
- Understanding Addiction Akers, R. L. (1992). Drugs, Alcohol, and Society: Social Structure, Process, and Policy. Monterey, CA: Brooks/Cole.
- Baer, J. S. , Marlatt, G. A. , & McMahon, R. J. (Eds. ) (1993). Addictive Behaviors Across the Life Span. Newbury Park, CA: Sage Publications.
- Bennett, L. A. , Reiss, D. , et al. (1987). The Alcoholic Family. New York: Basic Books.
- Blevins, G. A. , Dana, R. Q. , & Lewis, J. A. (1994). Substance Abuse Counseling: An Individual Approach (2nd ed. ). Pacific Grove, CA: Brooks/Cole.
- Cohen, W Holstein, M. E. , & Inaba, D. S. (1997). Uppers, Downers, All Arounders: Physical . E. , and Mental Effects of Psychoactive Drugs (3rd ed. ).
- Ashland, OR: CNS Publications. Collins, R. L. , Leonard, K. E. , & Searles, J. S. (Eds. ) (1990). Alcohol and the Family: Research and Clinical Perspectives. New York: Guilford Press.
- Curtis, O. (1998). Chemical Dependency: A Family Affair. Pacific Grove, CA: Brooks/Cole.
- Epstein, E. E. , & McCrady, B. S. (Eds. ) (1999). Addictions: A Comprehensive Guidebook. New York: Oxford University Press.
- Fisher, G. L. , & Harrison, T. C. (2004). Substance Abuse: Information for School Counselors, Social Workers, Therapists, and Counselors. Boston: Allyn & Bacon.
- Gullotta, T. P Adams, G. R. , & Montemayor, R. (Eds. ) (1994). Substance Misuse in Adolescence. ., Thousand Oaks, CA: Sage Publications.
- Jaffe, J. (Ed. ) (1995). Encyclopedia of Drugs and Alcohol. New York: Macmillan.
- Jonnes, J. (1999). Hep-Cats, Narcs, and Pipe Dreams: A History of America’s Romance With Illegal Drugs. Baltimore: Johns Hopkins University Press.
- Kinney, J. (2003). Loosening the Grip: A Handbook of Alcohol Information (7th ed. ). New York: McGraw-Hill.
- Lawson, A. W Lawson, G. W & Rivers, P (1996). Essentials of Chemical Dependency . C. Counseling (2nd ed. ). Gaithersburg, MD: Aspen Publishers.